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General NPI Number Information
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NPI Number | 1497130165
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Entity Type | Organization
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Legal Business Name | DIVINE ANGELS BEHAVIORAL CENTER
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 304 LANCE AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89030-3844
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Country | US
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Telephone | 702-684-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 304 LANCE AVE
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City | N LAS VEGAS
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State | NV
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Zip | 89030-3844
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Country | US
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Telephone | 702-684-3457
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MS. CHARISSE MARIE NEAL
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Credential |
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Telephone | 702-684-3457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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